Intensive care medicine
-
Intensive care medicine · Apr 2002
What is the optimal duration of ventilation in the prone position in acute lung injury and acute respiratory distress syndrome?
To evaluate the effects of prone ventilation on respiratory parameters and extravascular lung water (EVLW) in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in order to characterise the optimal duration of ventilation in the prone position. ⋯ Over the 18 h period studied there was progressive improvement in gas exchange, pulmonary shunt and EVLW. Although it is not possible to exclude that improvement over this period was unrelated to prone positioning, these findings suggests that ventilation in the prone position for more prolonged periods may be required for optimal improvement and warrants further study.
-
Intensive care medicine · Apr 2002
Review Randomized Controlled Trial Clinical TrialRelationship between ventilatory settings and barotrauma in the acute respiratory distress syndrome.
High pressures or volumes may increase the risk of barotrauma in the acute respiratory distress syndrome (ARDS). ⋯ Clinical studies maintaining P(plat) lower than 35 cmH(2)O found no apparent relationship between ventilatory parameters and pneumothorax. Analysis of the literature suggests a correlation when patients receive mechanical ventilation with P(plat) levels exceeding 35 cmH(2)O.
-
Intensive care medicine · Apr 2002
Randomized Controlled Trial Clinical TrialSelective decontamination of subglottic area in mechanically ventilated patients with multiple trauma.
To determine whether selective decontamination locally in the subglottic area (SDSA) reduces tracheal colonization and prevents ventilator-associated pneumonia (VAP) in patients with multiple trauma. ⋯ The SDSA is an effective and safe type of chemoprophylaxis against tracheal colonization and can significantly reduce the incidence of VAP in mechanically ventilated patients with multiple trauma.
-
Intensive care medicine · Apr 2002
Comparative StudyCardiac output measurement by pulse dye densitometry: a comparison with the Fick's principle and thermodilution method.
To evaluate the agreement between cardiac output (CO) measurements obtained by a new dye dilution technique using pulse dye densitometry (PDD) and thermodilution (TD) and the direct Fick method (F). ⋯ Comparison between PDD and TD showed good agreement for the normal to high CO range. However, agreement was poor in patients with low CO. In the latter patient group PDD showed relevant underestimation of CO compared to TD and F. Due to these limitations PDD cannot entirely replace the pulmonary artery catheter for CO determination.
-
Intensive care medicine · Apr 2002
Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery.
We hypothesized that measuring stroke volume variation (SVV) during mechanical ventilation by continuous arterial pulse contour analysis allows the accurate prediction and monitoring of changes in cardiac index (CI) in response to volume administration. ⋯ SVV may help to determine the preload condition of ventilated patients following cardiac surgery and to predict and continuously monitor effects of volume administered as part of their hemodynamic management.